Nur 138 Final Exam

Causes of dysrythmias

Smoking Alcohol consumption Caffeine intake Stress & anxiety Obesity Physical inactivity Poor diet Substance abuse Sleep disorders Dehydration & electrolyte imbalances

Benzodiazepines

The most common group of antianxiety drugs, which includes Valium and Xanax. Don't give for PTSD Prevent / reduce anxiety without too much sedation. Ex: Versed is a sedative hypnotic anxiolytic given pre-procedures. Makes the patient forget about the procedure. Common complications: CNS depression and trouble recalling things that occur after taking a dose. Respiratory depression and decreased BP. Taper to stop! Withdrawal is as dangerous as alcohol withdrawal.

Seizure Care and Management

Timekeeping: Note the exact time of seizure onset and duration for accurate documentation and evaluation. Recovery position: Place the patient on their side to maintain an open airway and prevent aspiration. Documentation: Carefully record details about the seizure, including type, location, and any associated behaviors. EEG limitations: While EEG can help diagnose epilepsy, a single normal EEG cannot rule out a seizure disorder. Protect the client from injury. Stay with the client until they are fully recovered.

airborne precautions and common diseases

Used for diseases that can be transmitted through tiny airborne particles that remain suspended in the air for an extended period. TB, measles, chicken pox, disseminated herpes zoster

Droplet precautions and common diseases

Used for diseases transmitted via respiratory droplets when the patient coughs, sneezes, talks, or breathes. Flu, Pertussis, mumps, COVID-19 Wear a mask, maintain 3 ft of separation, proper hand hygiene, patient has to wear a mask if leaving the room.

what is a protective environment and the diseases that might need it?

Used for patients with compromised immune systems, such as those who have undergone bone marrow transplants or organ transplants. Or who have cancer. The goal is to protect the patient from environmental pathogens. Maintain strict hand hygiene, use sterile techniques when handling invasive devices, limit visitors and ensure that visitors follow infection control measures.

Normal Blood Flow

Vena cavas to the right atrium, tri-cuspid valve, right ventricle, pulmonary arteries, left atrium, mitral valve (bicuspid), left ventricle, aortic valve, to aorta and out to the body.

Care of client after exposure to allergen

Epipen, then go to the ER Keep the epipen room temperature, keep it with you, make sure it's at room temperature, train all the people around you

Strategies for cancer prevention and early detection:

No smoking Eating a healthy diet Maintaining a healthy weight Exercising regularly: Exercise can help reduce the risk of cancer and improve overall health. Protecting yourself from the sun Mammograms for breast cancer: Women over 40 should get regular mammograms. Pap smears for cervical cancer: Women should get regular pap smears starting at age 21. Colon cancer screening: Men and women over 50 should get regular colon cancer screening. HPV Vaccine for both sexes after the age of 10, sexually active

Nursing actions to decrease cancer cells and support normal cell function:

Nutrition: Eat a healthy diet that is low in processed foods and high in fruits, vegetables, and whole grains. Exercise: Get regular exercise, such as 30 minutes of moderate-intensity activity most days of the week. Sleep: Get enough sleep, which is typically 7-8 hours per night. Stress management: Find healthy ways to manage stress, such as yoga, meditation, or spending time in nature. "SHED" -> sleep, hydrate, exercise, diet

Early warning signs of cancer (CAUTION)

"CAUTION" C = change in bowel or bladder habits. A = a sore that does not heal U = unusual bleeding or discharge T = thickening or lump in the breast or elsewhere I = indigestion or difficulty swallowing O = obvious change in wart or mole N = nagging cough or hoarseness

Hemophilia Bleeding Episode Management

- Assess and document location and severity of bleeding episodes. - apply pressure or use ice packs covered with cloth to control bleeding from minor cuts or abrasions. - elevate and immobilize the affected limb if joint bleeding is suspected. - Administer pain relief as needed (avoid NSAIDs and other meds that could worsen bleeding) - Administer factor 8 or 10 as ordered.

Patent ductus arteriosus

a blood vessel in a fetus that bypasses pulmonary circulation by connecting the pulmonary artery directly to the ascending aorta Keep PDA open with Prostaglandin Close PDA with Indomethacin

Defects that decrease PBF

Pulmonary atresia Pulmonary Stenosis tetralogy of fallot Obstruction of pulm blood flow and a right to left shunt. S&S: Squatting Cyanosis Clubbing Syncope

Care of a client at risk for suicide

Remove any lethal means from the client's environment. Stay with the client or ensure close supervision. Encourage the client to talk about their suicidal thoughts and feelings. Help the client connect with mental health resources.

Sickle cell crisis treatment

Rest, hydration, and avoid high altitude and strenuous activities Sickle Cell Crisis or vaso-occlusive crisis is a painful episode caused by sickle cells getting stuck in capillaries and causing lack of O2 in the body. The most common trigger is dehydration, but can also be caused by infection/illness, extreme temperatures, stress and emotional factors, and physical stress or overexertion. Any condition that increases the body's need for O2 may trigger a sickling episode. Each sickling episode weakens the cell membrane and greatly decreases the normal lifespan (120 days) of RBCs. Sickled RBCs can return to a less sickled (but never completely normal) shape with adequate hydration and oxygenation. This allows the cells to more easily travel through the circulatory system. The triad of treatment for sickle cell crisis consists of oxygenation, hydration, and pain management. NOTE: It is also important to address the psychosocial needs of patients and their families.

Lithium Carbonate

a chemical used to counteract mood swings of bipolar disorder Alters neurotransmission in the CNS Not recommended during pregnancy / breastfeeding, for patients with kidney problems, CHF, organic brain disease, or for patients on sodium-restricted diets. • Onset of action 1-3 weeks. Dosage gradually increased until at therapeutic blood level of 0.6-1.2 mEq/L Narrow therapeutic window!! Carefully monitor. Asian patients may experience toxicity at lower doses. Toxic symptoms at blood levels >1.5 mEq/L

Carbidopa/Levodopa

Sinemet (CR) Antiparkinson Agent o Carbidopa and Levidopa are the key and usually given together. Carvedopa is the vehicle to bring levodopa to the brain. § Urine and sweat can be dark-colored Providers hold off on starting until later in the disease course b/c it stops being effective. So they start with dopamine agonists. § Levodopa is dopamine. § Carbidopa makes sure that it gets to the brain and isn't peripherally metabolized. When the carbidopa is effective, you need less Levodopa. § Take it 2 hrs before or 2 hrs after you eat! § Will need to take a "vacation" from this med

Borderline Personality Disorder S&S

"I DESPAIR" o I = identity; unstable identity --> it changes from moment to moment based on who they're around. o D = dysphoria, a chronic feeling of emptiness. o E = emotional instability. Feel emotions very strongly! Can feel rage instead of annoyance; panic instead of anxiety. Drastic swings between emotions (affective lability). o S = self harm and suicide. Often engage in self harm like cutting. Frequent suicidal thoughts and attempts. They are chronically suicidal. o P = psychotic / dissociative symptoms. Auditory hallucinations, paranoia. Psychosis symptoms are transient and occur in times of severe interpersonal stress. o A = anger. Experience anger and irritability on a daily basis. Not all people with BPD will show outward anger. o I = impulsivity. Won't consider consequences of their actions, like drugs, unsafe sex, unsafe driving. Motivated by the escape of pain, rather than seeking pleasure. o R = relationships are difficult. Pattern of short lived and unstable relationships.

Ulcerative Colitis

"UC Blood" "uLcerative Pain" == pain is in the left lower quadrant 5-30 mucousy stools a day BMs will decrease the pain focused in the large intestine and rectum Mucosa layer is the most affected. Continuous ulcers Anemia no cure unless rectum & colon removed.

How to conduct a suicide assessment

Ask direct questions about suicidal thoughts and plans. Assess for risk factors, such as depression, hopelessness, and access to lethal means. Use a suicide assessment tool, such as the Beck Scale for Suicide Ideation. Make a safety plan with the client.

Nitrate Patient Education

- in acute angina attacks, take sublingual ever 5 minutes up to 3 times. Avoid alcohol & other meds for low BP Do not stop abruptly

Hemophilia

-Hemophilia A: deficiency in Factor VIII -Hemophilia B (Christmas disease): deficiency in Factor IX -Transmitted from mother to son; Sex-linked recessive disorder on X chromosome - the blood lacks clotting factors, leading to excessive bleeding (internal in muscles and joints or external). Can cause chronic joint disease and pain.

Mixed Defects

-Transposition of the great arteries -Total anomalous pulmonary venous return Combo of defects that results in mixing of O2 saturated and desaturated blood, leading to desaturated systemic blood flow. S&S: cyanosis, pulmonary congestion, and CHF.

Four types of Heart Defects

1. Defects that increase Pulmonary Blood Flow (PBF) 2. Defects that decrease Pulmonary Blood Flow (PBF) 3. Defects that result in Obstructed Systemic Blood Flow 4. Mixed Defects

Post op care

1. monitor VS, pain, level of consciousness, and surgical site for bleeding/infection / other complications. 2. Follow orders for wound care, ensuring proper hand hygiene and sterile technique. 3. Encourage early mobility and ambulation as appropriate. 4. manage pain thru meds and non pharma methods. 5. Fluids and nutrition 6. Respiratory care - encourage deep breathing exercises and coughing. 7. Med management 8. Diet & Bowels --> start with a clear liquid diet and progress as tolerated. Monitor BMs and provide stool softeners/laxatives as ordered. 9. Education & communication.

What is included in a physical assessment for immunity?

Assess lymph nodes, temperature, mobility, general appearance, skin, history of infections, immunization status

Expected Laboratory Value Changes with Stress Response:

Cortisol: Increases significantly during stress response, mobilizing energy and resources. Glucose: Levels rise as the body prepares for a "fight-or-flight" response.

Normal Sinus Rhythm

60-100 bpm Rhythm is regular Ratio of P: QRS is 1:1 T wave is present after each QRS complex PR interval = 0.12 - 0.2 sec (P wave until beginning of QRS) QRS complex = 0.06 - 0.10 sec (time is half of the PR interval)

Complications of NSAID use in older adults

> GI : NSAIDs can irritate the stomach lining and increase the risk of ulcers and bleeding. > Kidneys: blood urea nitrogen, creatinine. NSAIDs can decrease blood flow to the kidneys leading to a decline in kidney function. This risk is particularly high in older adults who may already have reduced kidney function. > Liver: AST/ALT elevated liver enzymes NSAIDs can cause a temporary increase in liver enzymes, which can indicate liver damage. > Heart attack and stroke: risk increased, especially in high doses and with long-term use. Additional considerations: Dehydration: Older adults are more susceptible to dehydration, which can exacerbate the risks associated with NSAIDs. Drinking plenty of fluids is crucial. Polypharmacy: Older adults often take multiple medications, which can increase the risk of interactions and side effects. Careful monitoring and coordination of medications are essential. Underlying health conditions: Certain underlying health conditions, such as diabetes and heart disease, can put older adults at higher risk of complications from NSAIDs. Laboratory monitoring: Regular monitoring of laboratory tests such as AST, ALT, blood urea nitrogen, creatinine, and electrolytes is crucial for detecting early signs of organ damage associated with NSAID use.

Recognize diagnostic lab changes that indicate infection

> High WBC (>10000) > Leukocytosis: Increased white blood cell count, indicating the body is fighting an infection. > Left shift: Increase in immature white blood cells, suggesting a more severe infection. > Elevated C-reactive protein (CRP): Marker of inflammation in the body. > Elevated erythrocyte sedimentation rate (ESR): Non-specific marker of inflammation. > Positive cultures: Growth of bacteria or other pathogens in a sample of body fluid.

Lifespan considerations for bipolar disorder

> Increase risk for suicide > Bipolar disorder can occur at any age, but it is most commonly diagnosed in late adolescence or early adulthood. > The course of the illness can vary greatly from person to person. > Some people experience only a few episodes of mania or depression, while others experience frequent episodes that can be debilitating. > Bipolar disorder can be a lifelong illness, but it can be managed with medication and therapy.

Nursing Care Mods with Hemophilia

> Minimize invasive procedures: Avoid unnecessary blood draws, injections, and other procedures that can cause bleeding. > Apply pressure to bleeding sites. > Use medications to control bleeding, such as factor replacement therapy. > Teach patients and families about the disease and how to manage it. > Don't give aspirin to patients with hemophilia, as it can increase the risk of bleeding. > Consider subq injections if possible to avoid intramuscular injections. > Be cautious with rectal or nasal procedures due to potential for bleeding. > Provide education and support to patients and families.

Phenytoin (Dilantin) nursing considerations

> Monitor Vit D (Dilantin decreases it) > Monitor for Gingival hyperplasia > Monitor and record seizure activity to assess the effectiveness > Regularly assess phenytoin blood levels and liver function. > Monitor for signs of adverse reactions, such as skin rashes or changes in gum health. > Use caution with intravenous (IV) administration, as it can lead to cardiac arrhythmias if given too rapidly. Administer slowly with a 0.22-micron filter.

Management of a client with sickle cell disease

>Lots of O2!!Hydrate!! >Treatment for sickle cell crisis is pain control, oxygenation, and fluid resuscitation. There is no cure for SCD. >Transfusions >Opioids for pain (morphine not demerol!, demerol can cause seizures) >Hydroxyurea - makes more fetal hemoglobin, but is cytotoxic >Might have to do a splenectomy if severe splenomegaly >Infections are a major cause of death in children with SCD. Children <5yo are often given prophylactic penicillin daily.Stem cell transplant, but risks get bigger as we get older.

Endocarditis S&S

>lung fluid >splenomegaly >fever >decreased O2 d/t decreased cardiac output >murmurs & clots >Splinter hemorrhages (fingernails) >Roth spots = retinal hemorrhages >Osler's nodes = pain, red lesions on the hands and feet. The body is trying to fight the infection >Janeway lesion = flat, circular lesions. Looks like someone has been putting out cigarettes on the

Wound assessment

Approximation: Are the edges of the wound close together? Dehiscence: Has the wound opened up? Purulent drainage: Is there any yellow or green drainage from the wound? Is there any redness, swelling, or tenderness around the wound? Is the wound covered and protected from infection?

Management of Angina

Ace inhibitor Beta blocker Calcium channel blocker Nitrates Outcomes = adequate circulation, adequate BP, reduced angina events

Active vs. Passive immunity

Active is honestly earned; long term - Vaccines: MMR - natural infection - Develops memory B cells that can quickly respond to future exposure to the antigen Passive is donation; short term - no memory developed - Rabies shot - Mom's breastmilk - Immunoglobulins (Rhogam, Covid) - Antivenom - Tetnus toxoid

Phenytoin (Dilantin

Anticonvulsant provide good ORAL CARE to prevent gingival hyperplasia (no reason to d/c) d/c: fever, skin rash (SJS), liver problems, allergic reactions, and lymphadenopathy risk for gait disturbance The therapeutic range = 10-20 micrograms per milliliter (mcg/mL)

antibody vs. antigen

Antigen (Ag) (aka Immunogen): A substance that causes the body to produce an immune response. Antibody (Ab): Proteins made in response to an Ag; can combine with that Ag.

Communication strategies for a client in crisis

Be calm and reassuring. Listen to the client without judgment. Ask open-ended questions. Avoid giving advice or trying to fix the situation. Validate the client's feelings. Encourage the client to seek professional help.

S&S of both Crohn's and Ulcerative Colitis

No difference across the sexes 15-30 most frequent for onset hereditary loss of electrolytes increased colorectal cancer risk hypoalbuminemia / anemia weight loss malnutrition / dehydration Acute cases: NPO

Nursing Care of a client with PTSD

Create a safe and supportive environment. Listen to the client's story without judgment. Help the client identify and manage triggers. Teach the client coping mechanisms for dealing with anxiety and flashbacks. Refer the client for psychotherapy and/or medication management.

Signs of of ICP

Cushing's Triad (low HR, Low RR, Widening pulse pressure): Brain gets crushed, so vitals crush down. Cheyne stokes respiration Nuchal rigidity Flexed dilated pupils & unequal about 8mm (2-6 mm is normal) Foot: Babinski reflex toes FAN OUT instead of curl down Seizure / Coma Abnormal posturing: (Decorticate and Decerebrate)

Client Education for Diazepam (Valium) Use:

CNS depressant effects: Diazepam can impair coordination and judgment, requiring caution with driving and other activities. Avoid alcohol: Combining diazepam with alcohol can dangerously enhance its sedative effects. Short-term use: Diazepam is typically prescribed for short-term management of anxiety or seizures. Seizure control mechanism: Diazepam works by decreasing activity in the central nervous system, thereby suppressing seizures.

NSAID Pharmacology

COX 1 blockage causes a decrease in platelet aggregation and kidney damage Cox 2 blockage decreases inflammation, fever, and pain Metabolized in the liver (CYP-450) Excreted via the kidneys

Benzos - Lifespan

Children • Response may be unpredictable; aggressiveness; crying; irritability • Monitor closely for CNS depression AND excitability Adults • Short-term use • Avoid driving and making important decisions • Check LFTs before starting and prn • Contraindicated in pregnant and lactating women Older Adults • Start with smaller doses; monitor closely for toxicity • Increased sedation, dizziness, hallucinations • Obtain baseline liver and renal function • Employ non-pharmacological measures to reduce anxiety and promote sleep

Precautions for infection control

Contact isolation: Used for infections that are spread through direct contact with an infected person or their body fluids. Standard isolation: Used for infections that are spread through contact with an infected person's respiratory secretions. Airborne isolation: Used for infections that are spread through the air when an infected person coughs or sneezes. Protective isolation: Used to protect a person with a weakened immune system from infection.

Dietary Recommendations for Iron Deficiency Anemia

Include iron-rich foods in your diet, such as red meat, beans, lentils, and leafy green vegetables.

tetralogy of fallot

Decrease Pulm Blood Flow P = pulmonary stenosis R= right ventricular hypertrophy O = Overriding Aorta V = Ventricular Septal Defect Blood will go from the high pressure left through the VSD. Normally, it would want to push it up the pulmonary artery but that's stenosed, so the right atria pushes it through the aorta and out to the body. Sometimes, there will be a 5th defect: patent foramen ovale. Need to keep the PDA open with prostaglandins. Without a PDA, hypoxia / cyanosis, systolic murmur, poor growth, clubbing of fingers, exercise intolerance, and... Hypercyanotic (Tet) spells: First thing you do is squat their legs to their body. This kinks the femoral artery and the veins in the lower extremities to increase systemic vascular resistance. This allows more blood to get to the lungs. Tx = surgery

antibiotics

Drugs that block the growth and reproduction of bacteria Side effects: nausea & vomiting, diarrhea, rash/itching, allergic rxns (hives, itching, swelling up to anaphylaxis), thrush, interferes with birth control Education: allergic rxn, birth control, complete the full course RN Considerations: Monitor for allergic rxn and adverse rxn, encourage good hygiene practices, assess for allergies.

Phenytoin (Dilantin) Patient Education

Educate the patient on the importance of consistent dosing and timing. Alcohol reduces it's effectiveness Wear a medical alert bracelet Be aware of adverse effects

Hyperplasia

Increase in the number of cells in a tissue or organ, resulting in the enlargement of that tissue.

High WBC (nursing interventions)

Infection - identify, then treat the infection

Creating a therapeutic milieu for a client with PTSD

Provide a consistent routine and structure. Minimize noise and chaos. Create opportunities for the client to express their feelings. Offer support and encouragement. Respect the client's boundaries.

CAD risk factors unique to women

early menopause (whether natural or as a result of surgery)oral contraceptive use (particularly in women who smoke)hormone replacement therapy (estrogen replacement therapy in menopause)Bilateral oophorectomy before age 35

Nitrate Side Effects

headache (d/t vasodilation), dizziness, flushing, nausea, orthostatic hypotension, tolerance over time.

LOW WBC (Nursing Interventions)

Neutropenic precautions: wear a mask, be careful of infections, avoid crowds Report any temp >100 to the doctor Avoid crowds and sick people Avoid yard work/gardening Don't change the cat littler box wash dishes in hot water or in the dishwasher. Also wash their toothbrush!

Indicators of a Systemic Reaction to Inflammation

Fever: A body temperature greater than 100.4°F (38°C) is a common indicator of inflammation. Increased heart rate: The heart rate typically increases in response to inflammation, as the body attempts to deliver more oxygen and nutrients to the affected area. Edema (swelling): Inflammation causes fluid build-up in tissues, leading to swelling in the affected area or throughout the body. Decreased urine output: When the body is fighting inflammation, it may retain fluids, leading to a decrease in urine output. This can be a serious sign of impaired kidney function. Respiratory changes: Rapid breathing or shortness of breath can be indicators of inflammation affecting the respiratory system. Altered mental status: In severe cases, inflammation can affect the brain, leading to confusion, disorientation, and other changes in mental status. Blood tests: Elevated levels of certain markers in the blood, such as C-reactive protein (CRP) and white blood cell count, can indicate the presence of inflammation in the body.

NSAID adverse reactions & contraindications

GI upset - local and systemic Increased bleeding - esp >60yo CNS effcts - dizziness, nervousnes Dermatological - rash Fulid retention / edema - bad for pt. with renal failure Contraindicated: > N = Nursing & Pregnancy > S = serious bleeding > A = allergy / asthma / angioedema > I = Impaired renal function > D = drugs that are anticoagulants

Define artificial, acquired passive immunity?

Given antibodies to the disease rather than developing them Ex: Immunoglobulins

Physiological symptoms of ICP

Headache: A severe, persistent headache is a common symptom of increased intracranial pressure. Noise sensitivity: Patients with IICP may be sensitive to loud noises due to increased pressure on the auditory nerves. Photophobia: Increased pressure can irritate the optic nerves, making patients sensitive to light. Decreased level of consciousness: As IICP progresses, patients may experience confusion, drowsiness, and even coma. Nausea and vomiting Blurred vision Seizures Changes in level of consciousness

How are Congenital Heart Defects categorized?

Hemodynamics: This classification focuses on how blood flows through the heart. Pathophysiology: This classification focuses on the specific anatomical abnormalities that cause the congenital heart defect.

Passive Immunity in vaccines

Hepatitis B Immunoglobulin (HBIG) is a passive immunity vaccine given right after exposure to prevent infection of Hep B (i.e. after a needle stick.) Rabies Immunoglobulin (RIG) is used to provide immediate immunity to individuals who have been exposed to rabies.

Indications and effects of synthetic erythropoietin:

Hormone released by the kidney to make RBCs Abnormal BUN/Creatinine could suggest poor kidney function, which leads to less erythropoietin, which results in less RBCs and then anemia Used to treat anemia caused by chronic kidney disease. Stimulates the production of red blood cells in the bone marrow. Can cause side effects such as headache, fatigue, and high blood pressure.

Nitrate contraindications

Known drug allergy, severe anemia, closed-angle glaucoma, hypotension, severe head injury, and concurrent use of the erectile dysfunction drugs: sildenafil (viagra), tadalafil (cialis), and vardenafil (levitra). Do not give nitrates within 24 hours of Viagra (sildenafil). Viagra and nitrates both cause blood vessels to relax and increase in size. This can cause blood pressure to drop. The drop in blood pressure can be severe and fatal.

Active Immunity in vaccines

MMR (weakened form) Flu (part of the virus) Active immunity stimulates the immune system to produce it's own antibodies to protect against those antigens.

Care of the client with Parkinson's

Meds: Carbidopa/Levodopa Assess symptoms: Tremors, weakness, gait Gag/swallow Mobility Bowel/Bladder Function UPDRS Maintenance Recommendations: Physical therapy Occupational therapy Regular exercise such as walking, swimming, cycling, and yoga Dance & Movement therapies Speech therapy Nutrition Stress Management (mindfulness, meditation) Assistive devices

Risk Factors for MI

Modifiable: smoking, high BP, high cholesterol, obesity, sedentary lifestyle, diabetes, Metabolic syndrome = waistline>40 for males, 35 for females; triglycerides >150; low HDL <50 for females, <40 for males; hypertension BP>135/85; fasting blood glucose >100 Early menopause Contraceptives Non-modifiable: Age: >60 Sex: equal after menopause Race / ethnicity Family history / genetics

Nursing activities for Crohn's and UC

Monitor fluid / electrolyte balance as this can impact cardiovascular system Monitor Daily weight WBC / CBC Stoma Care: should look red and beefy Nutrition support Pain Management Education & emotional support Monitor for complications such as fistulas, abscesses, strictures, or bowel obstructions.

Nursing Care of a Client with a cardiac dysrhythmia

Monitor vital signs, including heart rate, blood pressure, and respiratory rate. Administer medications Educate the client Provide emotional support Labs: Troponin levels elevated indicate cardiac muscle damage. Electrolyte imbalances can affect cardiac function. Recognize signs and symptoms of low cardiac output: Decreased urine output, confusion, shortness of breath, hypoactive bowel sounds.

Borderline Personality Disorder (BPD)

More prevalent in females (Borderline B*tch) Labile Emotions, Splitting & Impulsivity. o Splitting = either you're good or bad, no inbetween. o unstable emotions, depression, self-harm (cutting) o Low self-esteem, intense self-criticism, disassociation o Negative affectivity, disinhibition, antagonism. o Severe dissociative symptoms (like feeling cut off from everyone)

Antisocial Personality Disorder (ASPD)

Mostly in males Manipulation. Characterized by a persistent pattern of manipulative behavior that infringes on the rights and safety of others. o Purposeful deception o Theft o Fraud o Deception o Violence o No feelings of guilt

Collaborative treatment plan for a client with leukemia:

Oncology Family Social work Dietitian

Pharmacological Management of ICP

Osmotic diuretics: Mannitol is a commonly used osmotic diuretic that draws fluid out of the brain and reduces swelling. Loop diuretics: Medications like Lasix increase urine output and help to decrease fluid volume in the body, including the brain. Antipyretics: Medications that reduce fever can help to decrease IICP by lowering metabolic rate and reducing brain inflammation. Pain relievers: Managing pain can help to prevent increases in IICP that can be triggered by discomfort. Laxatives: Stool softeners can help prevent constipation and straining, which can increase pressure within the skull. Anticonvulsants: Medications to control seizures. Barbiturates: Medications to induce a coma to reduce brain activity.

PQRST

P = Atria depolarizes, sending a charge out through the SA node. Atria contract at the end of the P wave before QRS starts. QRS wave = ventricles depolarize / decompress. Sending a charge out through the AV node. Ventricles contract at the end of the QRS wave. T wave = ventricles relax / repolarize and refill with blood.

Defects that increase Pulmonary Blood Flow

Patent ductus arteriosus (PDA) Atrial septal defect (ASD) Ventricular septal defect (VSD) allows blood to shunt left to right, which causes increased pulm blood flow. S&S = HF S&S - increased fatigue - heart murmur - increased risk of endocarditis - CHF - growth retardation

Nursing interventions / strategies that promote sensorimotor ability post-stroke

Physical therapy: Enables patients to regain strength, balance, and coordination for walking, movement, and activities of daily living. Occupational therapy: Helps patients relearn essential skills for self-care, feeding, fine motor control, and adapting to their limitations.

Assessment findings indicative of stress

Physical: Muscle tension, fidgeting, sweating, changes in heart rate and breathing, hyperventilation, pacing. Psychological: Anxiety, irritability, difficulty concentrating, changes in appetite or sleep patterns. Behavioral: Increased use of tobacco, alcohol, or other substances, social withdrawal, changes in hygiene or self-care.

Contact precautions and diseases

Private room - door can be open Gloves Gown- if giving direct care Handwashing Disposable supplies Dedicated equipment MRSA, C Diff, Scabies, Multidrug-resistant organisms (MRDOs).

Recognition and management of a "tet" spell

Symptoms: Hypercyanosis (blue skin color), tachypnea (rapid breathing), irritability, lethargy. Management: > Knee-to-chest position: This helps to increase blood flow to the lungs and decrease cyanosis. > Calming techniques > Oxygen therapy

Discharge teaching instructions for a patient with iron deficiency anemia:

Take iron supplements Vitamin C helps the body absorb iron. Avoid taking iron with antacids or dairy products: they can interfere with the absorption of iron. Teeth: Iron supplements can stain teeth. Brush your teeth regularly and use a fluoride toothpaste. Glossitis/Pernicious anemia tongue is red and smooth and can feel sore. Can also get mouth fissures and cracks. Must use alcohol free mouthwash

Nursing Assessment for Infection

Take the client's history Assess the degree of risk for infection through observation and interview. Physical assessment - local infection = warm, redness, swelling, pain, loss of function. Systemic infection = fever, increased pulse, fatigue, loss of appetite, enlarged/tender lymph nodes. Assessing for infection is important to catch it quickly. Particularly for patients with IVs, indwelling catheters, surgical wounds.

How does a client with OCD affect family dynamics

The client's rituals and obsessions can be disruptive to the family. The family may feel overwhelmed and frustrated. The family may need to learn how to cope with the client's OCD.

endocarditis

inflammation of the inner lining of the heart (endocardium) More common on the left side Usually caused by an infection: bacterial or fungi. Staph and strep can cause endocarditis. Endocarditis affects the inner lining of the heart. Bacteria goes through the bloodstream and finds it's way to the heart At risk: -people with bad teeth -IV drug users -People with artificial valves -People with congenital heart defects

Dysplasia

abnormal growth, development, or maturation of cells. Considered a pre-cancerous condition, as it represents disorganized/atypical growth pattern.

Right sided stroke

affects left side, unilateral neglect, safety impulses, uninhibited & have perceptual deficits Right brain controls the Rs: reckless and really creative. S&S: - lack of impulse control - behavioral changes - left hemiparesis - left sided neglect Teach families about impulse control and behavioral changes

Left sided stroke

affects right side, slow, deliberate and aphasic Left side affects the right side of the body and controls the "L"s: language and logic. S&S = - dysphagia / speech - reading / writing problems - right sided hemiparesis - right sided neglect

Breast Cancer S&S

lump or mass change in breast size or shape Skin changes (redness, resembles an orange peel, dimpling, or puckering) Nipple changes like inversion, discharge, crusty/scaly rash Breast pain Swelling in breast or underarm unexplained weight loss change in breast sensation (tingling or numbness)

Nitrates / Nitrites

nitroglycerin Used to treat and prevent angina and can control BP by relaxing smooth muscles in blood vessels, resulting in vasodilation or coronary arteries (increases blood flow to heart) and peripheral arteris/veins (reduces afterload and preload to reduce heart workload).

NSAIDs

non-opioid analgesics Used to treat inflammation, analgesics, fever reduction, dysmenorrhea, and inhibition of platelet aggregation (Aspirin) NSAIDS block the COX enzymes thereby decreasing the production of prostaglandins. Prostaglandins are lipids made at sites of tissue damage/ infection that control inflammation, pain, fever, blood flow, the formation of clots, and the induction of labor. Contraindicated in pregnancy. NSAID use during the third trimester may cause premature closure of the fetal ductus arteriosus, fetal renal impairment, inhibition of platelet aggregation, and may delay labor and birth.

Obstructive Defects

coarctation of the aorta aortic stenosis Hypoplastic Left Heart Syndrome Systemic blood flow is the problem. These are defects where the blood flow exiting the heart is blocked, preventing sufficient blood flow to the body. Pressure before the stenosis is higher; after is lower.

anaplasia

complete lack of differentiation in cells and subsequent loss of normal cellular characteristics and functions. A hallmark of highly aggressive and undifferentiated cancer cells.

Benzo RN Considerations

contraindicated if pregnant/nursing, with sleep apnea, respiratory depression, glaucoma Don't use with other CNS depressants, alcohol, opioids, anticonvulsants. Fatty foods and antacids decrease the absorption. Give at night with food grapefruit slows metabolism and increases the effects. Antibiotics and St. John's wort increase the effects. antiplatelet and SSRIs increase the risk for bleeding.

Crohn's S&S

diarrhea, less likely to be bloody cRohn's pain is in the Right lower quadrant "Gums to Bums" Entire bowel wall is affected, which leads to fistulas. skip lesions/patches = looks like cobblestones Infections like peritonitis, abcesses, and sepsis.

General Stroke Nursing Interventions.

o 1 - sided weakness leaves to dysphagia: NPO until a swallow screen is performed. Flex the neck when swallowing! Put the chin to the chest o Avoid sedating meds before meals o HOB is up o Dysphagia: Puree diet & Add thickening agents to meals o Seizure precautions o Frequent neuro assessments o Cluster care to avoid sensory overload o Transferring: Always use a transfer belt! This is due to the 1-sided weakness. Always pivot on the distal foot, and transfer the client toward the stronger side first o Avoid completing tasks for the client! This helps retain independence. § Provide instructions to avoid ADLs § Patiently allow time for the patient to understand each instruction § Simple gestures and pictures § Ask yes/no questions in a normal voice (not a loud voice) · Understanding is the problem, not hearing

Nitrate RN Considerations

physical assessment - particuarly BP and HR before and after taking; assess for nitrate tolerance; assess for side effects; monitor for drug/drug interactions. Nitrates may enhance anticoagulant effects of warfarin, so monitor PT

Metaplasia

reversible change in which one type of adult cell is replaced by another adult cell. this can be in response to chronic irritation or stress- for example, transformation of normal

ASPD S&S

§ ACID LIAR (3+ or 7 need to be in place) § A = adult, with the pattern starting at the age of 15 if not earlier. It begins in childhood, but can't be diagnosed until the patient is an adult. § C = criminality. Engage in actions outside of the law: stealing, drug trafficking. § I = impulsivity. Highly impulsive and will often act on a whim without considering the consequences of their actions. · Correlated with low conscientiousness § D = disregard for safety. Ignore or show outright disdain for the safety of others. Such as speeding where children are playing. § L = lying. Often done for some kind of secondary gain, but sometimes just for the thrill of it. § I = irresponsibility. Manifestation of the lack of conscientiousness. Won't repay debts, care for children, and are unwilling to work. § A = aggression. Physical aggression and violence are a manifestation of ASPD. Not purposeless, usually. Instead, people with ASPD tend to attack others in a purposeful or targeted way. § R = remorselessness. Lack of remorse for their actions, such as trying to rationalize aggressive behavior by saying the other person deserved it.